Tuberculous meningitis - symptoms and routes of spread, clinical picture, treatment methods. What is tuberculous meningitis
Tuberculous meningitis is an inflammatory process in the membranes of the brain and spinal cord. It is not contagious, so contact with a sick person cannot provoke the development of pathology. The root cause of the disease is always active or previous tuberculosis.
Until recently, the disease was considered fatal, but currently in 15-25% of cases a person can be saved. However, a positive outcome is only possible if treatment is started immediately after the first symptoms appear.
How are other causes transmitted?
The causative agent of tuberculous meningitis is a pathogenic acid-resistant mycobacterium. It is characterized by virulence, that is, the ability to infect the body. The degree of damage in each case will be different, it all depends on the characteristics of the individual’s body and external factors.
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The development of tuberculosis, which is the starting point for meningitis, is in most cases provoked by human or bovine pathogens. Mycobacterium M. Bovis is most often isolated in villages and villages, where it is transmitted through nutrition. People with immunodeficiency disease are also at risk of contracting avian tuberculosis.
Bovis and other representatives of the Mycobacterium species are prokaryotes: their cytoplasm does not contain highly organized organelles of the Golgi apparatus and lysosomes. On the other hand, mycobacteria also lack plasmids characteristic of some prokaryotes, which are responsible for the dynamics of the genome of microorganisms.
The shape of the mycobacterium resembles a straight or slightly curved rod with slightly rounded ends. Most of these microorganisms are thin and long with dimensions of 1-10 µm × 0.2-0.6 µm. However, the bullish species is always thicker and shorter.
Mycobacteria are immobile, do not form microspores and capsules, and their structure is as follows:
- microcapsule;
- cell wall;
- homogeneous bacterial cytoplasm;
- cytoplasmic membrane;
- nuclear substance.
The microcapsule is a wall of 3-4 layers with a thickness of 200-250 nm. It consists of polysaccharides and protects mycobacteria from environmental influences.
The microcapsule is securely attached to the cell wall, which provides the microorganism with mechanical, osmotic and chemical protection. The cell wall contains lipids - it is their phosphatidic fraction that ensures the virulence of the entire Mycobacterium species.
The main carriers of the antigenic properties of mycobacteria are proteins, including tuberculin. Antibodies are detected by polysaccharides in the blood serum of tuberculosis patients. Lipids are responsible for the resistance of microorganisms to acids and alkalis.
Tuberculosis affects many organs in the human body: lungs, bones, kidneys, skin, intestines, lymph nodes. As a result, “cold” inflammation occurs, which most often has a granulomatous nature and provokes the appearance of a large number of tubercles that are prone to decay.
Course of the disease
The main source of mycobacteria entering the membranes of the brain is considered to be hematogenous. The entire pathological process develops over two stages.
First, sensitization of the body occurs. Mycobacteria break through the blood-brain barrier, infecting the choroid plexuses of the pia mater of the brain. After this, the microorganisms move into the cerebrospinal fluid, where they provoke the development of bacillary meningitis - a specific inflammation of the membranes at the base of the brain.
As mycobacteria move through the body, microscopic tubercles are formed in the tissues of the brain and in its meningeal membranes, which can also appear in the bones of the spine and skull. Another cause of tuberculosis can be miliary tuberculosis.
It is tubercles that cause the development of three pathological processes that represent the clinical picture of tuberculous meningitis:
- inflammation of the meningeal membranes;
- formation of a gray jelly mass at the base of the brain;
- inflammation and narrowing of the arteries leading to the brain, followed by local brain damage.
As the disease progresses, not only the meninges begin to suffer, but also the walls of the brain vessels. Pathologists attribute these pathological changes to the results of hyperergic inflammation.
The brain parenchyma suffers less in tuberculous meningitis. Although foci of inflammation are found in the cortex, subcortex and trunk, they are usually localized only near the affected vessels.
Classification
In total, there are three types of tuberculous meningitis, which are characterized by the degree of prevalence and the specific location of the disease:
| Basilar |
|
| Cerebrospinal meningoencephalitis |
|
| Serous tuberculous meningitis |
|
With the meningeal form of the disease, the patient is likely to have a favorable outcome. Complications and relapses in such cases are extremely rare.
Symptoms of tuberculous meningitis
In young children, and especially in newborns, symptoms of tuberculous meningitis are much more common than in adults.
There are three periods of development of the disease:
- premonitory;
- irritation;
- terminal (paresis, irritation).
The prodromal period lasts from one to eight weeks, and is characterized by gradual development. The first signs are headache and dizziness. Then nausea appears, and less often, fever.
The patient complains of retention of stool and urination, increased body temperature. However, science knows of cases where the disease proceeded without changes in temperature.
After 8-14 days, symptoms suddenly worsen. Body temperature rises sharply to a critical level of 38-39 degrees, pain appears in the forehead and back of the head. The patient feels drowsiness, weakness throughout the body, clouding of consciousness.
A little later, constipation without bloating, intolerance to light and noise, and hyperesthesia of the skin appear. On the part of the vegetative-vascular system, persistent dermographism is observed. Red spots appear on the face and chest, which disappear as suddenly as they appear.
After a week from the onset of symptoms, patients develop a mild meningeal syndrome, also known as Kernig and Brudzinski’s symptom, which is accompanied by headache, nausea and stiffness of the neck muscles.
When the content of serous exudate in the body is exceeded, irritation of the cranial nerves occurs at the base of the brain.
This condition is accompanied by a number of symptoms, including:
- vision problems;
- strabismus;
- eyelid paralysis;
- deafness;
- differently dilated pupils;
- swelling of the fundus.
In the presence of hydrocephalus, the severity of the disease does not matter: in all cases, the exudate blocks certain cerebrospinal connections to the brain, which can cause fainting. If such symptoms are observed regularly, they may portend an unfavorable outcome for patients.
If the exudate blocks the spinal cord, the patient may experience not only weakness of the motor nerves, but also paralysis of both legs.
On days 15-24 of the disease, the terminal period begins, which is characterized by symptoms of encephalitis, including:
- loss of consciousness;
- tachycardia;
- Cheyne-Stokes breathing;
- extremely high temperature – 40 degrees;
- paraplegia;
- paresis.
The spinal form in the second and third periods is characterized by severe girdling pain, paralysis of both legs and bedsores.
Diagnostics
Ideally, the diagnosis of tuberculous meningitis should be made after ten days from the onset of symptoms. In this case, the chances of a favorable treatment outcome will be maximum. Diagnosis after 15 days is considered late.
The diagnosis of tuberculous meningitis is not easy to make.
An alarm signal should be the presence of all signs of the disease at once:
- prodrome;
- intoxication;
- constipation, difficulty urinating;
- navicular abdomen;
- symptoms of traumatic brain injury;
- a certain character of cerebrospinal fluid;
- clinical dynamics.
The location of tuberculosis infection in the body can be anywhere.
Therefore, when examining a patient, doctors pay attention to the presence of:
- tuberculosis of lymph nodes;
- X-ray results showing signs of tuberculosis;
- enlarged liver and/or spleen;
- choroidal tuberculosis.
The insidiousness of the disease is that even at a severe stage, the tuberculin test may turn out to be negative.
Fortunately, there are other signs that help recognize the disease during diagnosis:
- high pressure in the spinal cord;
- clear cerebrospinal fluid;
- formation of a fibrin network;
- increased protein content - 0.8-1.5-2.0 g/l with a norm of 0.15-
0.45 g/l. - low blood sugar.
Both and are characterized by a sudden and acute onset. Tuberculous meningitis in HIV-infected people progresses more slowly, but is no less severe. The only joyful fact is that mycobacteria are detected in only 1 out of 10 people.
A high probability of developing the disease is demonstrated by tuberculosis damage to organs or the presence of relatives who have suffered tuberculosis. In this case, the most reliable way to confirm or refute the diagnosis is to obtain cerebrospinal fluid during a spinal puncture.
Treatment
At the first suspicion of tuberculous meningitis, a person requires urgent hospitalization in a hospital. In a medical facility, doctors will be able to take an X-ray, perform a laboratory examination, and perform a spinal function. An accurate diagnosis will help you choose the right treatment.
If tuberculous meningitis is left untreated, it can be fatal.
Treatment of complications
The most terrible diagnosis that a patient with tuberculosis can hear is “occlusive hydrocephalus.”
These require vigorous dehydration therapy:
- glucose injections;
- magnesium sulfate intramuscularly;
- massages;
- morning work-out;
- physiotherapy.
Specific methods of treating tuberculosis depend on the location of the lesion - pulmonary, bone or other. Serious surgical interventions are possible only a year after final recovery and discharge from the hospital.
However, the treatment itself does not end there. After completing inpatient treatment, the patient is recommended to go to a sanatorium, where specific therapy will continue for 4-5 months.
Returning home, the patient must carry out specific therapy for the next 18 months on his own. After completion of treatment, it is recommended to carry out antibacterial treatment for the next 2 years: in spring and autumn for 2-3 months.
Prevention
Basically, tuberculosis is common among socially disadvantaged sections of the population.
There are five main factors that provoke the development of the disease:
- poor socio-economic conditions;
- low standard of living;
- a large number of people without a fixed place of residence;
- high unemployment;
- increase in the number of illegal migrants.
According to statistics, men suffer from tuberculosis 3.3 times more often than women, and the incidence of infection does not depend on the region of residence. Citizens aged 20 to 39 years are more susceptible to the disease.
Another statistical fact: tuberculosis among prisoners in Russian correctional institutions is 42 times more common than the national average.
To prevent the disease, the following methods are used:
- preventive and anti-epidemic measures;
- identifying patients at early stages;
- allocation of funds for medicines;
- organizing mandatory medical examinations when hiring on farms where cases of bovine tuberculosis have been recorded;
- relocation to isolated living space of tuberculosis patients who live in communal apartments;
- organization of primary vaccination.
Dispensary observation
After hospital treatment for tuberculous meningitis, the patient should be observed by a doctor for another 2-3 years to eliminate the risk of relapse of the disease.
Since the consequences of tuberculous meningitis can be quite serious, the question of ability to work or continue education can be raised at least 1 year after discharge from the hospital. However, even after this time, patients are not recommended to return to physical labor. They are also contraindicated from sudden temperature changes.
During inpatient treatment, the patient is given strict bed rest for 1-2 months. After this, he is prescribed a more gentle regimen, during which he is allowed to eat sedentary meals, walk around the ward, and use the toilet. Then the patient is transferred to a training regimen, during which he goes to the dining room, walks around the territory of the medical facility and takes part in labor processes.
After complete recovery, the patient is transferred from the anti-tuberculosis dispensary to a medical institution at the place of residence, where the patient is assigned to 1 dispensary group.
When the patient does not visit the hospital for research, health care workers should monitor him regularly. For the first year after discharge, doctors should visit the patient at home.
It is important that the former patient is not influenced by factors that can provoke a relapse:
- hypothermia;
- excessive physical activity:
- overheating;
- premature return to work.
If in the first year there are pronounced signs of residual effects, the person is assigned disability group 1, he is considered disabled and needs constant care. If the condition is satisfactory, the person is recognized as professionally disabled, but not in need of care. A year after complete recovery, the former patient can return to work.
Despite the fact that tuberculous meningitis is a very serious disease, it can be treated using modern methods. Up to 80% of those cured successfully return to their profession or continue to study.
Tuberculous meningitis is an inflammation of the soft membrane of the brain. In most cases, the disease is a complication of another form of tuberculosis. The category of people who have already suffered from this inflammatory process in any form is no exception. The disease is most often diagnosed in adults. The main risk group is people aged 40–70 years.
If treatment of the disease is not started in a timely manner, death cannot be ruled out.
Etiology
The etiology of this disease is well studied. The most common provoking factors for the development of the pathological process are the following:
- any localization;
- weakened immune system;
- severe infectious diseases;
- intoxication of the body;
- open brain injuries.
Due to certain etiological factors, the acid-resistant bacterium Mycobakterium enters the body. This serves as a prerequisite for the development of tuberculous meningitis. But it should be noted that the development of an inflammatory disease is more likely if a person has a severely weakened immune system.
Pathogenesis
Due to certain etiological factors, the provoking bacterium enters the body through the hematogenous route (with the blood). After this, the infectious organism settles on the soft membrane of the brain, where it begins to reproduce. At this stage, the human body tries to develop protection. A capsule is formed that temporarily localizes the infection. As the infection progresses, the capsule ruptures and infectious organisms enter the cerebrospinal fluid. Thus, tuberculous meningitis develops.
General symptoms
At the initial stages, tuberculous meningitis may not make itself felt at all, since the pathological process develops slowly. As this complication of tuberculosis develops, the symptoms become more pronounced.
A person affected by the infection may experience the following symptoms:
- apathy;
- drowsiness;
- weakness and malaise;
- increased body temperature;
- frequent headaches;
- changes in tone in the muscles of the neck and back of the head;
- nausea, occasionally vomiting.
In more severe cases, the patient may experience partial paralysis, which is associated with disturbances in the functioning of the nervous system and brain.
In addition to the above symptoms, some patients may be diagnosed with heart rhythm disturbances - or.
Stages of disease development
In official medicine, it is customary to distinguish the following stages of development of tuberculous meningitis:
- prodromal(feeling worse, headaches appear);
- excitement(symptoms of muscle stiffness, intense headaches appear, muscle pain, vomiting, and psychological disorders also begin);
- oppression(possible paralysis, coma).
Detection of the disease at an early stage of development practically eliminates the risk of serious complications, but subject to correct treatment. Therefore, at the first symptoms you should immediately consult a doctor.
Diagnostics
At the first signs, you should immediately consult a therapist. After a thorough personal examination and medical history, a comprehensive diagnosis is carried out.
Laboratory tests consist only of a general blood and urine test. If necessary, a biochemical blood test may be prescribed.
As for instrumental analyses, the following research methods are used:
- fluorography;
- test for tuberculosis (Mantoux);
- cerebrospinal fluid puncture;
Based on the results obtained, the doctor can make an accurate diagnosis and prescribe the correct treatment.
Treatment
Treatment of tuberculous meningitis is carried out only inpatiently. In the initial stages of tuberculous meningitis, patients may be prescribed the following drugs:
- isoniazid;
- rifampicin;
- pyrazinamide;
- streptomycin.
The dosage and frequency of administration are determined only by the attending physician. On average, the duration of therapy lasts about 6–12 months. But, the duration of treatment may vary depending on the general condition of the patient and the form of development of the disease.
In addition to special-purpose drugs, the patient is prescribed medications to strengthen the immune system. Also, during the period of treatment of tuberculous meningitis, the patient should eat well and in a timely manner.
It should be noted that tuberculous meningitis is a kind of last stage in the development of this pathological process. Therefore, all infectious and inflammatory diseases must be treated to the end so as not to cause such complications.
Treatment with folk remedies
Traditional medicine offers many remedies for the treatment of tuberculous meningitis. But, you can take any of them only as prescribed by your doctor.
The traditional method of treatment involves taking herbal decoctions from the following herbs:
- lungwort;
- marshmallow infusion;
- elecampane root;
From the above herbs you can prepare both decoctions and tinctures. But, they should be used on the recommendation of a doctor. Self-medication is not acceptable.
Prevention
Despite the fact that tuberculous meningitis is a dangerous disease, it can be prevented if simple preventive measures are applied in practice.
For children, an effective measure to prevent the disease is vaccination. This vaccination should be done at 7 and 14 years of age.
In addition, the following rules should be applied in practice:
- regular ventilation of the room and wet cleaning;
- compliance with personal hygiene rules;
- regular examination by a therapist;
- undergoing fluorography.
Such preventive measures make it possible, if not to completely avoid this disease, then to significantly reduce the risk of its formation. It is much easier to prevent any disease than to treat it later.
Self-medication with such a diagnosis is strictly contraindicated.
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Chronic fatigue syndrome (abbr. CFS) is a condition in which mental and physical weakness occurs, caused by unknown factors and lasting from six months or more. Chronic fatigue syndrome, the symptoms of which are believed to be to some extent associated with infectious diseases, is also closely associated with the accelerated pace of life of the population and with the increased flow of information literally falling on a person for subsequent perception.
is an acute disease in which the membranes of the brain are affected by the tuberculosis bacillus and become inflamed. It is a complication of pulmonary tuberculosis. This article will describe the causes and mechanisms of its occurrence, the main symptoms, principles of diagnosis and treatment.
Causes and mechanisms of development
Tuberculous meningitis develops in people who already have pulmonary tuberculosis. The causative agent is Koch's tuberculosis bacillus.
Mycobacterium tuberculosis is an acid-fast bacterium. A person becomes infected with it through airborne droplets. The source of infection is a sick person. Nowadays, there is a significant increase in the incidence of tuberculosis. Doctors note that morbidity rates are approaching epidemic levels.
Bacteria enter the membranes of the brain through the bloodstream, hematogenously. First, they settle on the vessels of the brain, and then penetrate into its membranes, and cause acute inflammation there. There are groups of people whose risk of developing this disease is increased. These include:
- people who have tuberculosis or those who have already completed a course of therapy;
- people with immunodeficiency - HIV, AIDS;
- people who have a weakened immune system;
- people who have recently been in contact with patients with open tuberculosis.
Clinical picture
Unlike bacterial or viral inflammation of the membranes of the brain, tuberculous meningitis does not develop at lightning speed, but gradually. This form of meningitis is characterized by the presence of a pro-normal period of the disease, in which the following symptoms may be observed:
- The appearance of a headache. First, the headache hurts in the evening, or during sleep, and then it becomes almost constant. This headache is hardly relieved by painkillers.
- Weakness, apathy, increased drowsiness.
- Significant loss of appetite, up to anorexia.
- Irritability and excessive nervousness.
All these symptoms develop due to gradually increasing intracranial pressure. Since the inflammatory process develops gradually, meningeal syndrome begins to appear only 7-10 days after the start of the pronormal period. The main symptoms of meningeal syndrome are presented in the table:
| Main symptoms of tuberculous meningitis | |
| Symptom name | General characteristics of the symptom |
| Stiffness of the neck and neck muscles | The muscles of the neck and occipital region become hard and inelastic. They have increased tone. The patient has difficulty bending or straightening his neck. The doctor, trying to bend it passively, feels resistance from the muscles. |
| Pointing dog pose | The patient lies on his side with his head thrown back, pressing his legs to his stomach. So it subconsciously slightly reduces intracranial pressure. |
| Headache | A headache of a bursting nature, which may be more pronounced in the forehead or temples. It is not reduced by painkillers. |
| Reaction to sound and light | Patients react very painfully to all sounds and bright lights, and are asked to close the curtains and not make noise. |
| Vomit | Vomiting occurs at the top of the headache. There is no nausea before her. This kind of vomiting does not bring relief. Vomiting occurs due to increased intracranial pressure. |
| Kernig's sign | The patient lies on his back, the doctor bends one leg at the hip and knee. But he cannot straighten his knee. This occurs due to high tension in the posterior femoral muscles, which causes flexion contracture. |
| Brudzinski's sign |
|
Principles of disease diagnosis
Tuberculous meningitis - symptoms
First of all, the doctor examines the patient, collects anamnesis and medical history. Then he examines him and checks for meningeal symptoms. Already at this stage of diagnosis, the doctor suspects the development of meningitis. But to prescribe treatment and make an accurate diagnosis, laboratory and instrumental diagnostics are indispensable.
The main research method is lumbar puncture. With its help, cerebrospinal fluid and cerebrospinal fluid are collected for analysis. Main characteristics of cerebrospinal fluid in tuberculous meningitis:
- Increased cerebrospinal fluid pressure during the puncture itself. With tuberculous meningitis, cerebrospinal fluid flows out in a stream or in frequent drops.
- If you put the liquor in the light, on the windowsill, for example, after an hour a film will fall out of it, which will glow under the rays of the sun.
- Increased number of cells in the cerebrospinal fluid. Normally, out of 3-5 in the field of view, and with tuberculous meningitis 200-600.
- The protein level in the cerebrospinal fluid rises to 1.5-2 grams per liter. The norm is 0.1-0.2.
- A decrease in glucose levels in the cerebrospinal fluid is observed only in patients who are not additionally infected with the HIV virus.
- Koch's tuberculosis bacillus can be isolated in 10% of the liquor.
In addition to lumbar puncture, the following examinations are performed:
- Plain radiography of the chest organs. It is needed to identify the primary tuberculosis focus.
- General blood analysis. It is needed to assess the severity of the inflammatory process in the body, as well as to determine the blood cell composition. With a reduced color index, erythrocyte hemoglobin, the patient will have anemia.
- Computed tomography of the brain is performed in acute forms of meningitis; it is needed to assess the volume of tissue affected by the inflammatory process.
- Sputum microscopy is used to detect acid-fast tuberculosis bacteria in sputum.
Basic principles of treatment of tuberculous meningitis
Treatment of tuberculous meningitis is carried out in intensive care units at tuberculosis dispensaries. Therapy for tuberculous meningitis includes:
- Strict bed rest.
- Constant monitoring of blood pressure, heart rate, oxygen and carbon dioxide levels in the blood.
- Oxygen support is provided through a mask.
- Taking anti-tuberculosis drugs. The regimen for these medications is developed by the attending physician. The standard regimen includes Isoniazid, Rifampicin, Ethambutol, Pyrazinamide. Before prescribing these drugs, a sensitivity test is carried out. Recently, cases of resistance of tuberculosis bacteria to standard treatment regimens have become more frequent.
- Detoxification therapy. Includes intravenous administration to the patient of such solutions as Ringer's solution, Trisol, Disol, Reosorbilact, Polyglucin. These drugs are administered together with diuretics (Furosemide, Lasix) to prevent the development of cerebral edema.
- Hepatoprotectors – are prescribed to protect the liver from the hepatotoxic effects of anti-tuberculosis drugs. These include Heptral, Milk Thistle, Karsil.
- Corticosteroids are prescribed for infectious-toxic shock.
Complications of tuberculous meningitis
The course of tuberculous meningitis can be complicated by the following conditions:
- Brain swelling;
- Infectious-toxic shock;
- Encephalitis - involvement of the tissues of the brain itself in the inflammatory process;
- Sepsis;
- Partial paralysis or paresis;
- Herniation of the brain;
- Impaired hearing, vision, speech.
Tuberculous meningitis is a complication of primary meningitis. Unlike other types of inflammation of the meninges, the disease does not develop quickly, but gradually, over 1-2 weeks. Such patients are treated in tuberculosis clinics, in intensive care units, under the constant supervision of medical personnel.
Shoshina Vera Nikolaevna
Therapist, education: Northern Medical University. Work experience 10 years.
Articles written
Mycobacterium tuberculosis penetrating into the meninges provokes tuberculous meningitis. Treatmentthis disease - a long and complex process, because it is based not only on a standard set of measures for meningitis, but also against tuberculosis.
The disease appears suddenly, completely incapacitating the person. Let's figure out what it is and how to deal with it.
Causesillnesses
Tuberculous meningitis was first diagnosed as a separate disease at the end of the 19th century. It was then that an analysis of the cerebrospinal fluid showed the presence of Mycobacterium tuberculosis in it. A century after this discovery, doctors came to a consensus that the main patients suffering from this disease are children and adolescents. Now this boundary has shifted a little, and adults have begun to suffer from this disease more.
The tuberculous form of meningitis mainly affects people who have been diagnosed with:
- alcoholism, drug addiction;
- malnutrition;
- reduced immunity.
Elderly people are also at risk. But more than 90% of cases of tuberculous meningitis are a secondary disease that developed because a person has or has had tuberculosis. Most often, the primary localization of the disease is diagnosed in the lungs. In cases where the localization is not established, such tuberculous meningitis will be designated “isolated”.
Typically, the source of tuberculous meningitis is tuberculosis that affects the following organs:
- lungs (disseminated type);
- genitals;
- bones;
- mammary gland;
- kidneys;
- larynx.
It is extremely rare to contract this disease through contact. This is possible in two cases:
- When a bacterium from the bones of the skull moves to the cerebral membrane.
- When a patient has spinal tuberculosis, and the bacterium has entered the lining of the spinal cord.
Interesting! More than 15% of diseases of this type occur inlymphogenousinfection.
The main route for such bacteria to enter the meninges is through the bloodstream. And this is due to the fact that the blood-brain barrier has increased permeability. Tissue damage occurs in the following order:
- choroid plexuses of the pia mater;
- cerebrospinal fluid, where the inflammatory process is provoked in the soft and arachnoid membrane;
- brain substance.
Each step can cause changes in the blood vessels of the brain: from necrosis to thrombosis, and this disrupts blood circulation in the organ, leading to complications and deterioration of the patient’s condition. In adult patients, the inflammatory process in the meninges has a focal localization with adhesions and scars, and in children it provokes hydrocephalus.
Symptoms by periods and clinical forms
The symptoms of tuberculous meningitis vary depending on the stage of the disease and what its clinical form is. When diagnosing, the voiced symptoms will be an excellent help in selecting treatment and making an accurate diagnosis.
Symptoms during the course
Doctors divide tuberculous meningitis into 3 courses:
Premonitory, which lasts about 7-14 days. During this period, the tuberculous form of meningitis is difficult to identify, because the symptoms are nonspecific. It is characterized by:
- Strong headache;
- a sharp deterioration in health, increased irritability and apathy;
- nausea and vomiting due to increased headache;
- persistent high temperature.
Irritations, in which all previous symptoms increase, body temperature rises to 39-40 degrees. The following symptoms characteristic of meningitis are also added:
- increased sensitivity to sounds, light, touch;
- drowsiness and lethargy;
- the skin becomes covered with scarlet spots, because the autonomic vascular system malfunctions;
- the muscle tissue of the back of the head becomes rigid;
- consciousness becomes confused and inhibited;
- "cop dog" pose.
Paresis and paralysis, which is characterized not only by sensory imbalance, but also by loss of consciousness and central paralysis. And:
- disturbances in cardiac and respiratory rhythm;
- convulsions;
- an increase in body temperature to 41 degrees and above or, conversely, a rapid drop in this indicator;
- paralysis of the brain centers responsible for the heart and breathing, which leads to death.
Symptoms of clinical forms
Tuberculous meningitis is usually divided into 3 main clinical forms:
Basilar, which in most cases has a prodromal period lasting from 7 to 35 days with its characteristic symptoms. When the disease passes into the period of irritation, cephalgia, vomiting and anorexia join the existing symptoms. The patient feels tired and constantly wants to sleep. Signs of brain dysfunction gradually appear:
- strabismus;
- drooping upper eyelid;
- hearing loss;
- decreased visual function;
- optic nerve congestion;
- facial asymmetry;
- dysphonia and dysarthria.
Meningoencephalitis, which most often occurs in the third period of the disease. It is characterized by all encephalitic symptoms left without treatment, they can lead to death:
- spastic paresis and/or paralysis;
- partial and/or complete loss of sensitivity;
- loss of consciousness;
- respiratory depression;
- tachycardia and arrhythmia;
- bedsores.
Spinal, which is diagnosed extremely rarely. Most often it begins with signs of damage to the cerebral membranes, which in the second or third period of the course of the disease are supplemented by girdle pain, since bacteria affect the spinal roots. Subsequently, the pain becomes constant and intense, and even narcotic painkillers do not relieve it. There is a failure in bowel and bladder emptying, and later flaccid paralysis occurs.
Diagnosis and treatment
Tuberculous meningitis and its diagnosis are the specialized areas of two specialists: a phthisiatrician and a neurologist. And the diagnosis begins with laboratory tests of cerebrospinal fluid, which is taken using lumbar fluid. Its changes are detected already at the prodrome stage. When analyzing fluids, special attention is paid to glucose levels. The worst prognosis is given to those patients who have low levels.
The following studies are also used in diagnosis:
- microscopy;
- PCR diagnostics;
- differential diagnosis;
- chest x-ray to determine areas of inflammation;
- Ultrasound of the abdomen;
- analysis of gastric secretions;
- analysis of fluids from bone marrow, lymph nodes, liver;
- tuberculosis test;
All this makes it possible to identify tuberculous meningitis. Treatment is prescribed specific, based on anti-tuberculosis therapy. Many doctors prefer to use a treatment regimen that includes Ethambutol, Isoniazid, Pyrazinamide and Rifampicin. First they are used parenterally, and later internally. Usually, improvement occurs after two months, at which time Ethambutol and Pyrazinamide are discontinued, and the dose of Isoniazid will be significantly reduced. The remaining medications are used for another 9-10 months.
At the same time as these medications, medications prescribed by the neurologist are taken. Most often, this treatment regimen is based on:
- Dehydrants (Furosemide, Mannitol and Hydrochlorotazide).
- Detoxifiers (saline solutions and Dextran infusions).
- Prescription of glutamic acid and vitamin complex.
- Glucocorticoids, which are injected into the subarachnoid space.
- Other means aimed at relieving symptoms.
For the first two months, the patient is prescribed bed rest, which is reduced gradually. By the end of the third month, light walking is allowed. Puncture and analysis of cerebrospinal fluid will show the effectiveness of treatment. After completion of treatment, the patient is kept under medical supervision for a long time, and he also undergoes a course of anti-relapse medications twice a year.
Prognosis, complications and prevention
Just a few decades ago, due to the lack of drugs for tuberculosis, this disease ended in the death of the patient, which occurred in the second week from the moment of illness. Now almost 92% of all patients recover. But only if diagnosis and treatment were timely. If not, then the consequences of the disease will be sad and serious. Most often this is hydrocephalus of the brain, but epileptic seizures are also common as a residual phenomenon after the disease.
Treatment of complications depends on them:
- Occlusive hydrocephalus is treated with glucose injections, magnesium sulfate and plasma injected into a vein.
- Central and peripheral paralysis - massage, gymnastics, as well as Proserin and Dibazol.
- Tuberculosis in the lungs, joints or other localizations can have extensive foci. They are removed surgically, but only after a year has passed from the moment of recovery from meningitis.
- Treatment in specialized sanatoriums.
Preventive measures at the national level include:
- isolated premises for such patients;
- early diagnosis activities to reduce the number of tuberculosis patients and their contact with other people;
- children within a month from the moment of their birth.
There are no specific preventive measures for personal implementation. Usually this means maintaining personal hygiene and a correct and healthy lifestyle. Otherwise, all other actions are entrusted to the state, and all because this disease is classified as social. And outbreaks of tuberculosis occur during periods when the standard of living in the country is falling.
At such moments, the number of citizens leading an antisocial lifestyle increases. This is what leads to tuberculous meningitis.
Statistics! The stronger sex always suffers from tuberculosis more often and more severely, unlike women. The incidence rate in men is 3.5 times higher, as is the growth rate of the disease - 2.5 times. The risk group is people aged 20-29 years and 30-40 years.
Life after illness
Dispensary observation is carried out for recovered patients for 2-3 years. Their ability to work is assessed no earlier than 12 months after recovery. Treatment is always inpatient. If there are residual effects after a severe illness, then such a patient is recognized as disabled and in need of care and supervision.
If residual effects are less pronounced, then disability is recognized, but the need for outside care is not. But often there are no residual effects or contraindications to work, so after some time the patient returns to professional activity and to his usual lifestyle.
Sometimes literally an hour is enough to understand that the disease has affected the body, but nothing can be done. The treatment will be long, painstaking and will take away a year of a happy life. To prevent this from happening, monitor your health and take all its signals about failures seriously and go to the doctor. The earlier the disease is detected, the easier it will be to cure.
Tuberculous meningitis
What is Tuberculous meningitis -
Hematogenous dissemination of MBT into the nervous system, into the structures surrounding the brain or spinal cord, causes meningitis.
Tuberculous meningitis- This is an inflammation of the meninges. Up to 80% of patients with tuberculous meningitis have either traces of previous tuberculosis of other localizations, or active tuberculosis of another localization at the moment.
What provokes / Causes of Tuberculous meningitis:
Pathogens of tuberculosis are mycobacteria - acid-fast bacteria of the genus Mycobacterium. A total of 74 species of such mycobacteria are known. They are widely distributed in soil, water, people and animals. However, tuberculosis in humans is caused by a conditionally isolated M. tuberculosis complex, which includes Mycobacterium tuberculosis(human species), Mycobacterium bovis (bovine species), Mycobacterium africanum, Mycobacterium bovis BCG (BCG strain), Mycobacterium microti, Mycobacterium canetti. Recently, it has included Mycobacterium pinnipedii, Mycobacterium caprae, which are phylogenetically related to Mycobacterium microti and Mycobacterium bovis. The main species characteristic of Mycobacterium tuberculosis (MBT) is pathogenicity, which manifests itself in virulence. Virulence can vary significantly depending on environmental factors and manifest itself differently depending on the state of the microorganism that is subject to bacterial aggression.
Tuberculosis in humans most often occurs when infected with human and bovine species of the pathogen. Isolation of M. bovis is observed mainly in residents of rural areas, where the route of transmission is mainly nutritional. Avian tuberculosis is also noted, which occurs mainly in immunodeficient carriers.
MBTs are prokaryotes (their cytoplasm does not contain highly organized organelles of the Golgi apparatus, lysosomes). There are also no plasmids characteristic of some prokaryotes that provide genome dynamics for microorganisms.
Shape: slightly curved or straight rod 1-10 µm × 0.2-0.6 µm. The ends are slightly rounded. They are usually long and thin, but bovine pathogens are thicker and shorter.
MBT are immobile and do not form microspores or capsules.
Differentiates in a bacterial cell:
- microcapsule - a wall of 3-4 layers 200-250 nm thick, firmly connected to the cell wall, consists of polysaccharides, protects mycobacterium from the external environment, does not have antigenic properties, but exhibits serological activity;
- cell wall - limits the mycobacterium from the outside, ensures stability of cell size and shape, mechanical, osmotic and chemical protection, includes virulence factors - lipids, the phosphatide fraction of which is associated with the virulence of mycobacteria;
- homogeneous bacterial cytoplasm;
- cytoplasmic membrane - includes lipoprotein complexes, enzyme systems, forms an intracytoplasmic membrane system (mesosome);
- nuclear substance - includes chromosomes and plasmids.
Proteins (tuberculoproteins) are the main carriers of the antigenic properties of MBT and exhibit specificity in delayed-type hypersensitivity reactions. These proteins include tuberculin. The detection of antibodies in the blood serum of tuberculosis patients is associated with polysaccharides. Lipid fractions contribute to the resistance of mycobacteria to acids and alkalis.
Mycobacterium tuberculosis is an aerobe, Mycobacterium bovis and Mycobacterium africanum are aerophiles.
In organs affected by tuberculosis (lungs, lymph nodes, skin, bones, kidneys, intestines, etc.) a specific “cold” tuberculous inflammation develops, which is predominantly granulomatous in nature and leads to the formation of multiple tubercles with a tendency to disintegrate.
Pathogenesis (what happens?) during Tuberculous meningitis:
The hematogenous route of penetration of MBT into the meninges is recognized as the main one. In this case, damage to the meninges occurs in two stages.
1. At the first stage of primary tuberculosis, sensitization of the body develops, the MBT breaks through the blood-brain barrier and infection of the choroid plexuses of the pia mater.
2. At the second stage, MBT from the choroid plexuses enter the cerebrospinal fluid, causing a specific inflammation of the soft meninges at the base of the brain - bacillary meningitis.
During the spread of MTB from the primary tuberculous focus or as a manifestation of miliary tuberculosis, microscopic tubercles appear in the brain tissue and meningeal membranes. Sometimes they can form in the bones of the skull or spine.
Tubercles can cause:
1. inflammation of the meningeal membranes;
2. formation of a gray jelly-like mass at the base of the brain;
3. inflammation and narrowing of the arteries leading to the brain, which in turn can cause local brain damage.
These three processes form the clinical picture of tuberculous meningitis.
The pathological process involves not only the membranes of the brain and spinal cord, but also blood vessels. All layers of the vascular wall are affected, but the intima is most affected. These changes are considered by pathologists as a manifestation of hyperergic inflammation. So, with tuberculous meningitis, the membranes and blood vessels of the brain are primarily affected. The brain parenchyma participates in the process to a much lesser extent. In the cortex, subcortex, trunk, and spinal cord, foci of specific inflammation are found mainly near the affected vessels.
Symptoms of Tuberculous meningitis:
Meningitis mainly affects children, especially young infants, and much less often adults.
Based on localization, the main forms of tuberculous meningitis are distinguished: basilar meningitis; meningoencephalitis; spinal meningitis.
There are 3 periods of development of tuberculous meningitis:
1) prodromal;
2) irritation;
3) terminal (paresis and paralysis).
Prodromal period characterized by gradual (over 1-8 weeks) development. First, headache, dizziness, nausea, sometimes vomiting, and fever appear. There is retention of urine and stool, the temperature is subfebrile, less often - high. However, there are known cases of the disease developing at normal temperatures.
Irritation period: 8-14 days after the prodrome, a sharp increase in symptoms occurs, body temperature is 38-39 ° C, pain in the frontal and occipital region of the head. Drowsiness, lethargy, and depression of consciousness increase. Constipation without bloating - scaphoid abdomen. Photophobia, skin hyperesthesia, noise intolerance. Autonomic-vascular disorders: persistent red dermographism, red spots spontaneously appear and quickly disappear on the skin of the face and chest.
At the end of the first week of the irritation period (on the 5-7th day), a vaguely defined meningeal syndrome appears (stiff neck, Kornig and Brudzinski's sign).
Characteristic manifestations of symptoms appear in the second period of irritation, depending on the localization of the inflammatory tuberculosis process.
With inflammation of the meningeal membranes, headaches, nausea and stiff neck are observed.
With the accumulation of serous exudate at the base of the brain, irritation of the cranial nerves may occur with the following symptoms: blurred vision, eyelid paralysis, strabismus, unequally dilated pupils, deafness. Edema of the fundus papilla is present in 40% of patients.
Involvement of the cerebral arteries in the pathological process can lead to loss of speech or weakness in the limbs. Any area of the brain can be damaged.
With hydrocephalus of varying severity, some cerebrospinal connections to the brain are blocked by exudate. Hydrocephalus is the main cause of loss of consciousness. Pathological manifestations may be persistent and indicate a poor prognosis for unconscious patients.
If the spinal cord is blocked by exudate, motor neuron weakness or paralysis of the lower extremities may occur.
Terminal period(period of paresis and paralysis, 15-24th day of illness). The clinical picture is dominated by signs of encephalitis: lack of consciousness, tachycardia, Cheyne-Stokes respiration, body temperature 40 °C, paresis, central paralysis.
In the spinal form, in the 2nd and 3rd periods, girdling, very severe radicular pain, flaccid paralysis, and bedsores are observed.
Diagnosis of Tuberculous meningitis:
Establishing a diagnosis:
- timely - within 10 days from the beginning of the irritation period;
- later - after 15 days.
The simultaneous presence of the following diagnostic features indicates a high probability of tuberculous meningitis:
1. Prodrome.
2. Intoxication syndrome.
3. Functional disorders of the pelvic organs (constipation, urinary retention).
4. Scaphoid abdomen.
5. Cranial symptoms.
6. The specific nature of the cerebrospinal fluid.
7. Relevant clinical dynamics.
Since tuberculosis infection can be located anywhere in the body, during examination it is necessary to pay attention to the presence of:
1) tuberculosis of the lymph nodes;
2) radiological signs of miliary pulmonary tuberculosis;
3) enlargement of the liver or spleen;
4) choroidal tuberculosis, detected during examination of the fundus of the eye.
The tuberculin test may be negative, especially in advanced stages of the disease (negative anergy).
Diagnostic signs of tuberculous meningitis when analyzing cerebrospinal fluid:
1. Pressure in the spinal canal is usually increased (fluid
the bone flows out in frequent drops or streams).
2. Appearance of CSF: initially transparent, later (through
24 hours) a fibrin network may form. If there is a blockade
the spinal cord is yellowish in color.
3. Cellular composition: 200-800 mm3 (norm 3-5).
4. Protein content is increased (0.8-1.5-2.0 g/l), norm 0.15-
0.45 g/l.
5. Sugar: its content is reduced by 90%, but may be normal in the early stages of the disease or in AIDS. This indicator is important for differential diagnosis with viral meningitis, in which the sugar content in the spinal fluid is normal.
6. Bacteriological examination of the CSF: MBT are detected only in 10% if the volume of spinal fluid is sufficient (10-12 ml). Flotation using centrifugation for 30 minutes at high speed can detect MBT in 90% of cases.
Tuberculosis of the meninges and central nervous system in adults remains the main cause of death.
It is necessary to carry out differential diagnosis with bacterial meningitis, viral meningitis and HIV cryptococcal meningitis. The first two are characterized by an acute onset. Cryptococcal meningitis develops relatively more slowly. The presence of tuberculosis in the family or the discovery of tuberculous damage to any organ makes the tuberculous origin of meningitis more likely. However, a reliable indication is to obtain cerebrospinal fluid (CSF) by spinal puncture.
Treatment of Tuberculous meningitis:
If there is a suspicion of tuberculous meningitis, the patient must be urgently hospitalized in a specialized medical institution, where an X-ray examination, spinal puncture, laboratory examination can be performed, and specific methods of anti-tuberculosis therapy can be applied.
If left untreated, the outcome is fatal. The earlier the diagnosis is made and treatment started, the clearer the patient’s consciousness at the time of treatment, the better the prognosis.
Prevention of Tuberculous meningitis:
Tuberculosis is one of the so-called social diseases, the occurrence of which is associated with the living conditions of the population. The reasons for the epidemiological problem with tuberculosis in our country are the deterioration of socio-economic conditions, a decrease in the living standards of the population, an increase in the number of people without a fixed place of residence and occupation, and the intensification of migration processes.
Men in all regions suffer from tuberculosis 3.2 times more often than women, while the growth rate of incidence in men is 2.5 times higher than in women. The most affected are persons aged 20 - 29 and 30 - 39 years.
The morbidity rate of contingents serving sentences in penal institutions of the Ministry of Internal Affairs of Russia is 42 times higher than the Russian average.
For the purpose of prevention, the following measures are necessary:
- carrying out preventive and anti-epidemic measures adequate to the current extremely unfavorable epidemiological situation regarding tuberculosis.
- early identification of patients and allocation of funds for drug provision. This measure will also be able to reduce the incidence of illness among people who come into contact with sick people in outbreaks.
- carrying out mandatory preliminary and periodic examinations upon entry to work on livestock farms affected by bovine tuberculosis.
- increasing the allocated isolated living space for patients suffering from active tuberculosis and living in crowded apartments and dormitories.
- timely implementation (up to 30 days of life) of primary vaccination for newborn children.
Which doctors should you contact if you have Tuberculous meningitis:
Is something bothering you? Do you want to know more detailed information about Tuberculous meningitis, its causes, symptoms, methods of treatment and prevention, the course of the disease and diet after it? Or do you need an inspection? You can make an appointment with a doctor– clinic Eurolab always at your service! The best doctors will examine you, study external signs and help you identify the disease by symptoms, advise you and provide the necessary assistance and make a diagnosis. you also can call a doctor at home. Clinic Eurolab open for you around the clock.
How to contact the clinic:
Phone number of our clinic in Kyiv: (+38 044) 206-20-00 (multi-channel). The clinic secretary will select a convenient day and time for you to visit the doctor. Our coordinates and directions are indicated. Look in more detail about all the clinic’s services on it.
(+38 044) 206-20-00
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You? It is necessary to take a very careful approach to your overall health. People don't pay enough attention symptoms of diseases and do not realize that these diseases can be life-threatening. There are many diseases that at first do not manifest themselves in our body, but in the end it turns out that, unfortunately, it is too late to treat them. Each disease has its own specific signs, characteristic external manifestations - the so-called symptoms of the disease. Identifying symptoms is the first step in diagnosing diseases in general. To do this, you just need to do it several times a year. be examined by a doctor, in order not only to prevent a terrible disease, but also to maintain a healthy spirit in the body and the organism as a whole.
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Other diseases from the group Diseases of the nervous system:
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| Brain abscess |
| Australian encephalitis |
| Angioneuroses |
| Arachnoiditis |
| Arterial aneurysms |
| Arteriovenous aneurysms |
| Arteriosinus anastomosis |
| Bacterial meningitis |
| Amyotrophic lateral sclerosis |
| Meniere's disease |
| Parkinson's disease |
| Friedreich's disease |
| Venezuelan equine encephalitis |
| Vibration disease |
| Viral meningitis |
| Exposure to ultra-high frequency electromagnetic fields |
| Effects of noise on the nervous system |
| Eastern equine encephalomyelitis |
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| Secondary purulent meningitis |
| Hemorrhagic stroke |
| Generalized idiopathic epilepsy and epileptic syndromes |
| Hepatocerebral dystrophy |
| Herpes zoster |
| Herpetic encephalitis |
| Hydrocephalus |
| Hyperkalemic form of paroxysmal myoplegia |
| Hypokalemic form of paroxysmal myoplegia |
| Hypothalamic syndrome |
| Fungal meningitis |
| Influenza encephalitis |
| Decompression sickness |
| Childhood epilepsy with paroxysmal activity on EEG in the occipital region |
| Cerebral palsy |
| Diabetic polyneuropathy |
| Dystrophic myotonia Rossolimo–Steinert–Kurshman |
| Benign childhood epilepsy with EEG peaks in the central temporal region |
| Benign familial idiopathic neonatal seizures |
| Benign recurrent serous meningitis of Mollare |
| Closed injuries of the spine and spinal cord |
| Western equine encephalomyelitis (encephalitis) |
| Infectious exanthema (Boston exanthema) |
| Hysterical neurosis |
| Ischemic stroke |
| California encephalitis |
| Candidal meningitis |
| Oxygen starvation |
| Tick-borne encephalitis |
| Coma |
| Mosquito viral encephalitis |
| Measles encephalitis |
| Cryptococcal meningitis |
| Lymphocytic choriomeningitis |
| Meningitis caused by Pseudomonas aeruginosa (pseudomonas meningitis) |
| Meningitis |
| Meningococcal meningitis |
| Myasthenia gravis |
| Migraine |
| Myelitis |
| Multifocal neuropathy |
| Disorders of the venous circulation of the brain |
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| Trigeminal neuralgia |
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| Obsessive-compulsive disorder |
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| Neurobrucellosis |
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| Tumors of the cerebral hemispheres |
| Acute lymphocytic choriomeningitis |
| Acute myelitis |
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| Brain swelling |
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| Fractures of the skull bones |
| Landouzy-Dejerine scapulohumeral-facial form |
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| Subacute sclerosing leukoencephalitis |
| Subacute sclerosing panencephalitis |
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| Poliomyelitis-like diseases |
| Malformations of the nervous system |
| Transient cerebrovascular accidents |
